Quilotórax antenatal en feto euploide con translucencia nucal aumentada en el primer trimestre

We report a pregnancy in which the fetus showed increased nuchal translucency in the first trimester and normal karyotype on amniocentesis. At 33 weeks’ gestation, right fetal hydrothorax, producing mediastinal displacement and associated with polyhydramnios, was noted. Preterm labor occurred at 33.4 weeks, with respiratory distress in the newborn, requiring thoracic drainage. The presence of lymphocytes in the drained fluid confirmed the diagnosis of chylothorax. Although the association between increased nuchal translucency with a normal karyotype and impaired perinatal outcome is well known, an association with chylothorax is infrequent.     

Hipofisitis linfocitaria en gestante de 34 semanas

We report the case of a 23-year-old woman at 33 + 4 weeks of pregnancy who was admitted for investigation of bitemporalhemianopsia and endocrine disruption. We discuss the main differential diagnoses by reviewing the pathophysiology of lymphocytic hypophysitis, as well as the management of this disease.     

Incarceración y torsión uterina en gestante

Uterine torsion is a rare event, especially in the absence of pregnancy. This complication is defined as a rotation of more than 45° around the long axis of the uterus and usually occurs along the transition between the body and the cervix. In two thirds of cases, the torsion is toward the right side. This event is usually caused by the presence of an abnormal condition that affects the uterus and/or the adjacent structures. Clinical manifestations may be acute or chronic, or even entirely absent, in which case the torsion is identified as an intraoperative finding. The diagnosis can only be confirmed during laparotomy. Because of vessel congestion in the broad ligament and the anterior position of the ovaries, low hysterotomy, usually performed at cesarean section, cannot be carried out in certain situations. Instead classical hysterotomy on the posterior surface of the uterus is performed.     

Gestación heterotópica en inseminación artificial

We report a case of heterotopic pregnancy, which is of interest due to its low incidence and the serious complications that can ensue when diagnosis is delayed. Most of the heterotopic pregnancies described occurred after in vitro fertilization techniques. These pregnancies are less frequent after artificial insemination and are exceptional in spontaneous pregnancies. Our objective is to emphasize the increase in this type of pregnancy in the last few years due to assisted reproduction techniques and to highlight the importance of early diagnosis.     

Síndrome metabólico en ginecología

Metabolic syndrome is defined by the constellation of multiple cardiovascular risk factors that include abdominal obesity, atherogenic dyslipidemia, hypertension and increased fasting glucose levels. This syndrome is an important public health problem, since it is associated with a 5-fold increase in the prevalence of diabetes type 2 and a 2-3-fold increase in that of cardiovascular disease.     

Amnioinfusión en rotura prematura de membranas en gestaciones pretérmino

Objective

To study the possibility of prenatal amnioinfusion as a therapeutic measure in premature rupture of membranes in preterm pregnancies.

Material and methods

We performed serialized transabdominal amnioinfusions in two patients with premature rupture of membranes in preterm pregnancy. Ringer's solution was instilled by abdominal puncture.

Results

We performed serialized transabdominal amnioinfusions until the 23rd week of pregnancy, after which time both patients showed normal amniotic fluid.

Conclusions

Transabdominal amnioinfusion is a valid therapeutic option in premature rupture of membranes in preterm pregnancy.     

Torsión anexial como causa de abdomen agudo en una paciente adolescente

Acute abdomen due to adnexal torsion in adolescence is rare. One of the main reasons this diagnosis is frequently missed at first presentation is the diverse clinical presentation. When ovarian torsion cannot be excluded, diagnostic laparoscopy should be performed.We present a rare case of ovarian and fallopian torsion in a 15-year-old girl who presented with acute lower left abdominal pain and was treated by laparoscopic surgery.     

Abordaje laparoscópico del dolor abdominal agudo en mujeres en edad fértil

Objectives

To assess the effectiveness of the laparoscopic approach in acute abdominal pain in women of reproductive age presenting to the Emergency Department.

Material and methods

We performed an observational, prospective study of acute abdominal pain treated by gynecological laparoscopic procedures. The main variables evaluated were the cause of pain, type of surgery, complications, and conversions to open surgery.

Results

Between January 2009 and December 2011, we performed 110 urgent laparoscopic interventions. The reasons for surgery were rupture of an ovarian cyst in 40 interventions (36.7%), an ectopic pregnancy in 24 (21.8%), a pelvic inflammatory disease in 23 (20.9%), adnexal torsion in 12 (10.9%), and other reasons in 11 (10%). In these 110 interventions, there was one case of postoperative bleeding requiring reintervention and one case of conversion.

Conclusions

The laparoscopic approach is safe and effective in urgent gynecological surgery.     

Cesárea en isquemia-histerectomía: nueva técnica para finalizar la gestación en pacientes con hipertensión arterial pulmonar

The association of pulmonary hypertension (PH) and pregnancy still leads to high maternal mortality.New treatments and a multidisciplinary approach have improved the course of pregnancies and fetal outcomes but not maternal prognosis.We observed that fetal evacuation and uterine involution coincides with marked worsening of maternal cardiac function, suggesting that the trigger is blood flow from the uterine muscle to the general circulation. This process acts as an autotransfusion and increases the pressure in the right heart to unsustainable limits. A new surgical technique, cesarean section in ischemia-hysterectomy, has been designed to prevent this event. This technique blocks uterine circulation before fetal extraction. We describe this technique and four cases.     

Síndrome hiperhemolítico en gestante con drepanocitosis: desenlace fatal

Sickle cell disease is characterized by the presence of abnormal hemoglobin. This entity primarily affects the black population. Diagnosis and treatment of sickle cell disease in pregnant women is essential as outcome can be fatal for both mother and fetus. We report the case of a pregnant black woman with sickle cell disease. The management and outcome are discussed.     

Embarazo ectópico primario en epiplón. Reporte de caso

Abdominal pregnancy occurs in one out of 10,000 deliveries. Omental ectopic pregnancy is the least common of these pregnancies and diagnosis is generally made during laparotomy. We report the case of a 28-year-old woman, secundigesta, secundípara, who presented with menstrual delay, cutaneous-mucosal pallor, and severe abdominal pain. During laparotomy, the presence of omentum was observed in the pelvis and uterus. Both adnexa were normal. A tumor was found on the inferior border of the omentum. The tumor was removed and partial omentectomy was performed. A primary omental ectopic pregnancy was diagnosed.     

Entrecruzamiento de cordones en la gestación gemelar monocorial monoamniótica

Monochorial monoamniotic twins are at high risk of fetal death due to the general complications seen in multiple gestations, as well as those specific to this type of pregnancy. The most severe complication in these pregnancies is fetal death due to cord entanglement, which occurs in almost all cases.Early ultrasonographic diagnosis and intensive prenatal surveillance are essential for the early detection of cord entanglement and the prevention of fetal death.The need for in-hospital management and the exact gestational age for delivery continue to generate controversy in the literature.     

Tasa de partos instrumentales en España

The Spanish Society of Gynaecology and Obstetric and several National and International Health bodies currently advocate a more physiological care instead of a more medicalised care. However, the incidence of instrumental deliveries is high in Spain (23%) compared with other Western Countries (10% rate), and the reason for some is not well justified, as 40% of these is done to prevent problems or teaching. Also, the use of forceps (52%) compared to the total number of instrumental deliveries is high (20% incidence). Instrumental delivery, particularly forceps, is a very important risk factor for grade III and IV tears, which in turn increase the risk of faecal and air incontinence in women. Thus, in this country it is vital to optimise the system to review the rate of instrumental deliveries and the use of forceps in the total.     

Actitud ante el diagnóstico prenatal de las complicaciones del cordón umbilical en gemelos monoamnióticos

Monoamniotic twin pregnancies are rare (1/10,000 pregnancies), but are associated with a high perinatal mortality rate (30-70%). Fetal death usually results from cord entanglement and/or knots, which are the most representative and hazardous complications. Currently, early and accurate ultrasound diagnosis of this type of twinning can be performed. Furthermore, several ultrasound signs have recently been reported that aid recognition of umbilical cord abnormalities and identification of blood flow compromise. Intensive monitoring with nonstress tests and ultrasonographic follow-up combined with improved neonatal care can decrease the mortality rate in monoamniotic pregnancies by 10%. However, the management of these pregnancies remains controversial. We report a case of knotting of the cords, prenatally detected at 31 weeks. The ultrasonographic findings allowed the obstetric management to be reconsidered, with excellent neonatal outcomes.     

Lesiones del tracto urinario en cirugía ginecológica

We retrospectively analyzed 27 patients with urinary tract injuries who underwent gynecologic surgery from January 1, 2001 to December 31, 2009. The type and timing of injury, diagnostic methods and management of urinary fistulas were evaluated.Twenty-seven urological injuries were incurred during 6,276 gynecologic surgical procedures, representing an incidence of 0.43%. There were 12 urethral injuries and 15 bladder injuries, with an incidence of 0.19% and 0.24%, respectively. Urinary tract injury was diagnosed intraoperatively in 15 patients (55.5%) and postoperatively in 12 (44.5%). Urinary fistulas occurred in nine patients (33%).Most of the urinary tract injuries occurring in gynecologic surgery had optimal results when diagnosed early and managed correctly.     

Riesgo de fracturas no vertebrales en mujeres posmenopáusicas en tratamiento antirresortivo

Objective

To determine the 5-year non-vertebral fracture risk in postmenopausal women on antiresorptive therapy.

Subjects and methods

We performed a cross-sectional multicenter study in 2,111 postmenopausal women receiving antiresorptive therapy in gynecological settings. The risk of fracture was evaluated by means of the FRACTURE Index. The influence of clinical parameters on the main variable was evaluated through linear and/or logistic regression, using the SAS v. 9.1.3 program.

Results

The mean age ± standard deviation was 61.0 ± 7.9 years. Densitometry was available in 60.5% of the women and showed a prevalence of osteopenia of 49.4% whereas that of osteoporosis was 42.4%. Biphosphonates were used in 59.3% of the women. When densitometry was available, 73.4% scored less than 6 points on the FRACTURE Index, and when densitometry was not available, 81.7% scored less than 4 points. The mean risk of non-vertebral fractures was 14.8 ± 5.3% and that of vertebral fractures was 4.0 ± 3.0%.

Conclusions

In this large group of postmenopausal women receiving antiresorptive treatment, the 5-year non-vertebral fracture risk, as assessed by the FRACTURE index, was three times higher than that of vertebral fracture.     

Prevención de la hemorragia posparto en una gestante afectada de síndrome de Hermansky-Pudlack

Hermansky-Pudlak syndrome is a multisystemic disease with autosomal recessive inheritance, mainly characterized by oculo-cutaneous albinism and impaired platelet aggregation. We describe the follow–up and end of pregnancy in a 30-year-old woman with this syndrome, as well as the measures carried out during labor to avoid bleeding complications due to platelet dysfunction. The pregnancy ended at 38.2 weeks through vaginal delivery, without epidural anesthesia and good maternal and fetal outcome.     

Adenocarcinoma de pulmón en gestante

Lung cancer is the most common neoplasm in developed countries and the first cause of cancerrelated death in men, although currently there has been a significant increase in women. It remains a rare condition during pregnancy, but the association of lung cancer and gestation has been increasing in recent years. It seems to be more aggressive and diagnosed mainly at advances stages during pregnancy. Choosing the most appropriate treatment is very difficult and there is not enough information to establish the management. We report a case of a 38 year-old pregnant woman with stage IIIA lung adenocarcinoma diagnosed in the 27th week. At week 29 a decision was made to terminate the pregnancy. As the tumour was unresectable, she subsequently underwent combined chemotherapy and radiotherapy.     

Amniodrenaje en el manejo del polihidramnios severo sintomático

Pregnancies complicated by hydramnios are at increased risk of both maternal and fetal complications. Amnioreduction can restore normal amniotic pressure, thus increasing maternal comfort and prolonging pregnancy by limiting the risk of preterm labor and rupture of membranes. We present our experience in the management of two patients with severe polyhydramnios who were treated with amnioreduction.